Practitioner reality – How I deal with chronic renal insufficiency (Proceedings) - Veterinary Healthcare
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Practitioner reality – How I deal with chronic renal insufficiency (Proceedings)


CVC IN BALTIMORE PROCEEDINGS


  • Permanent damage to any part of the nephron
  • Multiple possibilities for inciting cause
  • Any age or sex cat, more common in older cats
  • Progressive disease

Signalment

  • History of polyuria/polydipsia
  • Usually weight loss
  • Anorexia
  • +/- vomiting
  • Bad breath
  • Lethargy

Physical exam findings

  • Dehydration
  • Unkempt cat
  • Kidneys may palpate small and irregular, occasionally large. Usually not painful upon palpation
  • Uremic breath, ulcers present in cats usually only end-stage

Diagnosis
  • Elevated BUN, Creatinine
  • Hypokalemia
  • Hyperphosphatemia
  • +/- anemia
  • Isosthenuria
  • +/- hypertension

Differential diagnosis

  • Prerenal azotemia – dehydration, high protein diet
  • Renal azotemia

o ARF
o CRF
o Diabetes
o Diuretics
  • Postrenal azotemia

IRIS staging

  • Stage 1: USG <1.030 with proteinuria or <1.025 without proteinuria, no azotemia, creatinine <1.6
  • Stage 2: Mild azotemia, creatinine 1.6-2.8, PU/PD and other clinical signs absent or minimal
  • Stage 3: Moderate azotemia, creatinine 2.8-5, clinical signs generally present
  • Stage 4: Severe azotemia, uremic syndrome, creatinine >5

Treatment

  • Fluids
  • Control vomiting/nausea
  • Dietary therapy
  • Phosphorus binders
  • Potassium supplements
  • Appetite stimulants
  • Manage anemia
  • Manage hypertension
  • Manage proteinuria
  • Calcitriol?

Practical management

  • Stage 1: Full bloodwork, BP, UA, +/- urine P/C ratio, +/- urine culture. Phosphorus binder if phosphorus over 3 (want to keep under 4), start dietary therapy? Recheck every 6 months with weight, UA, bloodwork
  • Stage 2: As above, but definite UP/C. Recheck every 4 months with weight and UA, Electrolytes +/- bloodwork as determined by history and PE, BP every 6 months
  • Stage 3: As above, recheck every 3 months. UA every visit +/- urine culture prn, culture every 6-9 months if otherwise stable. Bloodwork and BP every 6 months.
  • Stage 4: Hospitalize and stabilize, recheck monthly.


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Source: CVC IN BALTIMORE PROCEEDINGS,
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